PRISE EN CHARGE DU PIED BOT VARUS ÉQUIN DE L’ENFANT, SELON LA MÉTHODE PONSETI ASSOCIÉE À LA CORRECTION PAR MASSAGE : EXPÉRIENCE DU CHU ANDRAINJATO FIANARANTSOA

REPRENDREIntroduction  : Le pied bot varus équin demeure une cause importante de handicap physique secondaire à une déficience congénitale de l'appareil locomoteur à Madagascar. Le retard de la prise en charge constitue un facteur de mauvais pronostic. L'objectif de cette étude est d'évaluer l'efficacité de la méthode de Ponseti associée au massage dans le traitement pied bot varus équin des grands enfants.Patients et méthodes  : Il s'agit d'une étude prospective, analytique et observationnelle réalisée sur une période de 12 mois, au sein du centre de prise en charge des pieds bots du CHU Andrainjato Fianarantsoa.Résultats  : Durant la période d'étude, 46 patients ont été inclus. L'âge moyen était de 2 ans et 4 mois, avec une prédominance masculine. Les enfants plus de 12 mois prédominaient avec 26 cas (56,52%). 39,1% des cas des enfants étaient nés à domicile par des matrones. Le massage traditionnel constituait le premier recours de traitement dans 30,4% des cas.Le délai entre l'âge de diagnostic et l'âge de la prise en charge varie de 2 semaines à 6 ans.Le score moyen de Pirani était de 5,5/6 pour les enfants âgés de plus de 12 mois et de 3/6 pour les enfants âgés de moins de 12 mois. La majorité des enfants (69,2%) poursuivaient un massage à domicile par la famille après les séries de plâtre. De bons résultats étaient constatés dans 50 % des enfants âgés de plus de 12 mois.Conclusion  : L'association de la méthode de Ponseti et du massage pratiqué à domicile améliore la prise en charge des formes tardives et sévères des pieds bots varus équins. La méconnaissance de cette technique et le recours aux traitements traditionnels sont les principales causes du retard de prise en charge de cette pathologie

Longevidade comparada e idade da maturidade sexual em doze anuros dos gêneros Boophis, Gephyromantis e Mantidactylus (Anura: Mantellidae) da floresta tropical de Madagascar

Apresentamos aqui dados sobre a idade na maturidade sexual e longevidade para algumas espécies de Mantellidae dos gêneros Boophis, Gephyromantis e Mantidactylus que habitam a floresta tropical de baixa altitude de Masoala (nordeste de Madagascar). Contagens de linhas de crescimento (LAGs) foram utilizadas para calcular a longevidade dessas espécies; esses dados contribuem para avaliações do nível de ameaça desses anuros. Boophis inclui espécies de médio a grande porte (SVL = 30–65 mm) que atingem a maturidade sexual em 1–3 anos e vivem de 3–9 anos (i.e., longevidade média). Mantidactylus e Gephyromatis incluem espécies de pequeno a grande porte (SVL = 22–107 e 35–49 mm, respectivamente) que atingem maturidade sexual em 1–3 anos e vivem de 1–8 e 3–7 anos, respectivamenteData on the age at sexual maturity and longevity of some mantellid species of the genera Boophis, Gephyromantis, and Mantidactylus that inhabit the low altitude rainforest of Masoala (northeastern Madagascar) are presented. Counts of lines of arrested growth (LAGs) were used to calculate longevity in these species; these data contribute to assessment of the threat level of the studied anurans. Boophis includes species of mediumto large-sized frogs (SVL = 30–65 mm) that attain sexual maturity in 1–3 years and live 3–9 years (i.e., mid-longevity). Mantidactylus and Gephyromatis include small- to largesized species (SVL = 22–107 mm and 35–49 mm, respectively) that attain sexually maturity in 1–3 years and live 1–8 and 3–7 years, respectivel

Resolving a taxonomic and nomenclatural puzzle in mantellid frogs: synonymization of Gephyromantis azzurrae with G. corvus, and description of Gephyromantis kintana sp. nov. from the Isalo Massif, western Madagascar

The genus Gephyromantis belongs to the species-rich family Mantellidae and is currently divided in six subgenera. Among these is the subgenus Phylacomantis, which currently includes four described species: Gephyromantis pseudoasper, G. corvus, G. azzurrae, and G. atsingy. The latter three species are distributed in western Madagascar, and two of them (G. azzurrae and G. corvus) occur in the Isalo Massif. Based on the analysis of molecular data (a fragment of the 16S rRNA gene), morphological inspection of museum specimens, and photographic comparisons, G. azzurrae is synonymised with G. corvus and the second Phylacomantis lineage of Isalo is described as G. kintana sp. nov. This medium-sized frog species (adult snout-vent length 35–44 mm) is assigned to this subgenus according to genetic and morphological similarities to the other known species of Phylacomantis. Gephyromantis kintana sp. nov. is known only from the Isalo Massif, while new records for G. corvus extend its range to ca. 200 km off its currently known distribution. These two taxa seem to occur in syntopy in at least one locality in Isalo, and the easiest way to distinguish them is the inspection of the ventral colouration, dark in G. corvus and dirty white in G. kintana.info:eu-repo/semantics/publishedVersio

Dissemination of multidrug resistant Acinetobacter baumannii in various hospitals of Antananarivo Madagascar

This study reports the dissemination of multidrug-resistant (MDR) OXA-23-producing Acinetobacter baumannii clones in hospitals in Antananarivo, Madagascar. A total of 53 carbapenem-resistant A. baumannii isolates were obtained from September 2006 to March 2009 in five hospitals. These resistant strains represent 44% of all A. baumannii isolates. The double disk synergy test was performed to screen for production of metallo-beta-lactamases. Polymerase chain reaction (PCR) and DNA sequencing were performed for the detection of bla(AmpC), bla(OXA-51),bla(OXA-23), bla(OXA-24), bla(IMP), bla(VIM). The presence of the insertion sequence ISAba1 relative to blaOXA-23 and blaOXA-51 was assessed by PCR. Isolates were typed by Rep-PCR. All the isolates were MDR and produced the OXA-23 carbapenemase, which was confirmed by sequencing. PCR analysis for AmpC and OXA-51 gave positive results for all strains studied. No isolates produced metallo-beta-lactamases. In all isolates ISAba1 laid upstream of blaOXA-23. The A. baumannii isolates were separated into two genotypes; genotype A had a higher prevalence (41 strains) than genotype B (12 strains). Genotype A was present in four hospitals, whilst genotype B had spread in two hospitals. The high frequency of MDR OXA-23-producing A. baumannii in various hospitals in Antananarivo is curious since carbapenems are not available in Madagascar, but it emphasises the need for infection control procedures and strict adherence to them to prevent the spread of these resistant organisms in Antananarivo and also the need to control the use of carbapenems in the future

In vitro activities of 18 antimicrobial agents against Staphylococcus aureus isolates from the Institut Pasteur of Madagascar

<p>Abstract</p> <p>Background</p> <p><it>Staphylococcus aureus</it>, one of the most frequently isolated pathogens in both hospitals and the community, has been particularly efficient at developing resistance to antimicrobial agents. In developed countries, as methicillin-resistant <it>S. aureus </it>(MRSA) has prevailed and, furthermore, as <it>S. aureus </it>with reduced susceptibility to vancomycin has emerged, the therapeutic options for the treatment of <it>S. aureus </it>infections have become limited. In developing countries and especially African countries very little is known concerning the resistance of <it>S. aureus </it>to antibiotics. In Madagascar no data exist concerning this resistance.</p> <p>Objective</p> <p>To update the current status of antibiotic resistance of <it>S. aureus </it>in Antananarivo, Madagascar.</p> <p>Methods</p> <p>Clinical <it>S. aureus </it>isolates were collected from patients at the Institut Pasteur of Madagascar from January 2001 to December 2005. Susceptibility tests with 18 antibiotics were performed by the disk diffusion method.</p> <p>Results</p> <p>Among a total of 574 isolates, 506 were from community-acquired infections and 68 from nosocomial infections. There was no significant difference in the methicillin resistance rate between community-acquired strains (33 of 506; 6.5%) and nosocomial strains (3 of 68, 4.4%). Many MRSA isolates were resistant to multiple classes of antibiotics. Resistance to tetracyclin, trimethoprim-sulfamethoxazole and erythromycin was more common. Among MRSA isolates resistance rates to rifampicin, fusidic acid, gentamicin and ciprofloxacin were lower than that observed with other drugs easily available in Madagascar. No isolates were resistant to glycopeptides.</p> <p>Conclusion</p> <p>The rate of methicillin-resistant <it>S. aureus </it>is not different between community-acquired and nosocomial infections and is still rather low in Madagascar.</p

Rectal Carriage of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacilli in Community Settings in Madagascar

BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacteria (ESBL-PE) emerged at the end of the 1980s, causing nosocomial outbreaks and/or hyperendemic situations in hospitals and long-term care facilities. In recent years, community-acquired infections due to ESBL-PE have spread worldwide, especially across developing countries including Madagascar. OBJECTIVES: This study aimed to determine the prevalence and risk factors of intestinal carriage of ESBL-PE in the community of Antananarivo. METHODS: Non-hospitalized patients were recruited in three health centers in different socio economic settings. Fresh stool collected were immediately plated on Drigalski agar containing 3 mg/liter of ceftriaxone. Gram-negative bacilli species were identified and ESBL production was tested by a double disk diffusion (cefotaxime and ceftazidime +/- clavulanate) assay. Characterization of ESBLs were perfomed by PCR and direct sequencing . Molecular epidemiology was analysed by Rep-PCR and ERIC-PCR. RESULTS: 484 patients were screened (sex ratio  = 1.03, median age 28 years). 53 ESBL-PE were isolated from 49 patients (carrier rate 10.1%). The isolates included Escherichia coli (31), Klebsiella pneumoniae (14), Enterobacter cloacae (3), Citrobacter freundii (3), Kluyvera spp. (1) and Pantoae sp.(1). In multivariate analysis, only the socioeconomic status of the head of household was independently associated with ESBL-PE carriage, poverty being the predominant risk factor. CONCLUSIONS: The prevalence of carriage of ESBL in the community of Antananarivo is one of the highest reported worldwide. This alarming spread of resistance genes should be stopped urgently by improving hygiene and streamlining the distribution and consumption of antibiotics

High prevalence of fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar

<p>Abstract</p> <p>Background</p> <p>Extended-spectrum β-lactamase (ESBL)-producing <it>Enterobacteriaceae </it>have spread worldwide but there are few reports on carriage in hospitals in low-income countries. ESBL-producing <it>Enterobacteriaceae </it>(ESBL-PE) have been increasingly isolated from nosocomial infections in Antananarivo, Madagascar.</p> <p>Methods</p> <p>we conducted a prevalence survey in a pediatric unit from March to April 2008 Patient rectal swabs were sampled on the first and the last day of hospitalization. Medical staff and environment were also sampled. Rectal and environmental swabs were immediately plated onto Drigalski agar supplemented with 3 mg/liter of ceftriaxon.</p> <p>Results</p> <p>Fecal carriage was detected in 21.2% of 244 infants on admission and 57.1% of 154 on discharge, after more than 48 hours of hospitalization (p < 0.001). The species most frequently detected on admission were <it>Escherichia coli and Klebsiella pneumoniae </it>(36.9%), whereas, on discharge, <it>K. pneumoniae </it>was the species most frequently detected (52.7%). ESBL-associated resistances were related to trimethoprim-sulfamethoxazole (91.3%), gentamicin (76.1%), ciprofloxacin (50.0%), but not to amikacin and imipenem. The increased prevalence of carriage during hospitalization was related to standard antimicrobial therapy.</p> <p>Conclusion</p> <p>The significant emergence of multidrug-resistant enteric pathogens in Malagasy hospitals poses a serious health threat requiring the implementation of surveillance and control measures for nosocomial infections.</p

Viral Hepatitis and Rapid Diagnostic Test Based Screening for HBsAg in HIV-infected Patients in Rural Tanzania.

\ud \ud Co-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania. Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA. Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32-47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/µL (IQR 97-439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2-13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8-99.6%) and specificity at 100% (95% CI, 98.9-100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0-6.4%) of patients. This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa

Molecular Characterisation of Trimethoprim Resistance in Escherichia coli and Klebsiella pneumoniae during a Two Year Intervention on Trimethoprim Use

BACKGROUND: Trimethoprim resistance is increasing in Enterobacteriaceae. In 2004-2006 an intervention on trimethoprim use was conducted in Kronoberg County, Sweden, resulting in 85% reduction in trimethoprim prescriptions. We investigated the distribution of dihydrofolate reductase (dfr)-genes and integrons in Escherichia coli and Klebsiella pneumoniae and the effect of the intervention on this distribution. METHODOLOGY/PRINCIPAL FINDINGS: Consecutively isolated E. coli (n = 320) and K. pneumoniae (n = 54) isolates phenotypically resistant to trimethoprim were studied. All were investigated for the presence of dfrA1, dfrA5, dfrA7, dfrA8, dfrA12, dfrA14, dfrA17 and integrons class I and II. Isolates negative for the seven dfr-genes (n = 12) were also screened for dfr2d, dfrA3, dfrA9, dfrA10, dfrA24 and dfrA26. These genes accounted for 96% of trimethoprim resistance in E. coli and 69% in K. pneumoniae. The most prevalent was dfrA1 in both species. This was followed by dfrA17 in E. coli which was only found in one K. pneumoniae isolate. Class I and II Integrons were more common in E. coli (85%) than in K. pneumoniae (57%). The distribution of dfr-genes did not change during the course of the 2-year intervention. CONCLUSIONS/SIGNIFICANCE: The differences observed between the studied species in terms of dfr-gene and integron prevalence indicated a low rate of dfr-gene transfer between these two species and highlighted the possible role of narrow host range plasmids in the spread of trimethoprim resistance. The stability of dfr-genes, despite large changes in the selective pressure, indirectly suggests a low fitness cost of dfr-gene carriage